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1 FortisBC Advanced Certificate (SEMAC) Grant Application T E W bcit.ca/semac DESCRIPTION ForitsBC is offering the FortisBC Grant for five students. These grants are available to new Aboriginal students in the Advanced Certificate (SEMAC) Program ELIGIBILITY CRITERIA > Accepted into the Program at. > Registered with the. ELIGIBILITY CONDITIONS > A recipient will receive part of the grant at the beginning of the program for textbooks and equipment. The cost of courses will be covered by the FortisBC grant funding as the student registers for the courses in the program, and completes all required forms. > A recipient will maintain satisfactory academic standing that includes attendance and grades, during the academic period for which a grant is given. SELECTION CRITERIA Applicants will be adjudicated on their complete application. > Personal and career development. > Interest in the field of energy management. > Must be a BC resident (official address in BC or currently residing in BC). > Phone, video conference, or in person discussion with SEMAC Program Head. APPLICATION CHECKLIST (Form A) Complete Applicant Information (Form B) Complete Personal Statement (Form C) Program Discussion Register with the Submit this form along with a copy of your approved pre-entry assessment form, to DEADLINE AND NOTIFICATION Applications will be reviewed once applications to the program has been approved. 1/5

2 FortisBC Advanced Certificate T E W bcit.ca/semac FORM A: APPLICATION Application Instructions: Please print legibly and sign with an ink pen. APPLICANT INFORMATION Last Name First Name Middle Name Male Female Address (No. and Street Name, Unit #) City Province Postal Code Phone Cell ID # Registered Program Start Date (if known) mm/yyyy Do you have access to a computer with video camera and audio capabilities? BC Resident (Official Address in BC or Currently Residing in BC) Do you give consent for to share information about your Aboriginal ancestry with FortisBC? Do you have internet access that can support web based video conferences? Have you applied to this grant before? Privacy Notice: collects personal information that you chose to provide through this application under the authority of section 26 (d) of the Freedom of Information and Protection of Privacy Act RSBC, 1996, c This information will be used to verify your eligibility, evaluate and advise you of the status of your application to receive a FortisBC Sustainability Energy Management Advanced Certificate (SEMAC) Grant. may also share and disclose your personal information with FortisBC for purposes of adjudicating and awarding a SEMAC grant, and if you are selected to receive a SEMAC grant, may also use and disclose your name, photo image, community of residence, and educational history to publicize, promote and advertise the Sustainability Energy Management Advanced Certificate (SEMAC) Program and the FortisBC Sustainability Energy Management Advanced Certificate (SEMAC) Grant. For further information or questions about the collection and use of personal information, contact the Associate Director, Information Access and Privacy, Tel: ; or by mail: Information Access and Privacy, British Columbia Institute of Technology, 3700 Willingdon Ave., Burnaby, BC V5G 3H2.

3 FortisBC Advanced Certificate T E W bcit.ca/semac FORM B: PERSONAL STATEMENT Application Instructions: Please print legibly or preferably attach a Word document that answers each question below. Share examples that outline your commitment to personal and/or career development. (What has motivated you to attend? What are your goals & values?) Describe your interest in and current knowledge of energy management and how you hope to integrate it into your community and/or career? What will your barriers or challenges be to being a successful graduate from the program?

4 FortisBC Advanced Certificate T E W bcit.ca/semac How will FortisBC Grant help you? FORM C: PROGRAM DISCUSSION INFORMATION Last Name First Name Program Student Number

5 FortisBC Advanced Certificate T E W bcit.ca/semac STUDENT TO COMPLETE Applicant instructions: Please provide notes that you gathered from your meeting with the SEMAC program head. List any recommendations provided by the program head about your preparation for the program. Please print legibly or preferably attach a Word document. Date of conversation Name of person contacted (SEMAC program head) I hereby declare that the information I have submitted on this application is true and correct. I understand that has a right to cancel this application if the information contained in it has been misrepresented. Applicant Signature Date

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